Background and Aims Breast cancer has a high incidence rate, and surgery remains the primary treatment. Breast-conserving surgery (BCS) is a common approach for early-stage breast cancer, but the breast conservation rate is low in China, and noticeable scars often result from traditional open BCS. Currently, endoscopic minimally invasive techniques, known for their postoperative cosmetic effects and high patient satisfaction, have been applied in breast surgery for BCS. However, due to the challenges in surgical procedures and intraoperative localization, their adoption is limited in China, and research data are scarce. This study was performed to compare the short-term efficacy of endoscopic BCS with open BCS in the treatment of early breast cancer and explore the clinical application value of endoscopic BCS.Methods The clinical data of patients with unilateral breast cancer (stage 0-Ⅱ) who underwent BCS in the Department of Breast and Thyroid Surgery of the First Affiliated Hospital of the Army Medical University from January 2019 to December 2022 were retrospectively collected. Among them, 79 patients underwent endoscopic BCS (endoscopic group), and 602 patients underwent traditional open BCS (open group). After 1∶1 propensity score matching (PSM) of baseline data, the relevant clinical variables were compared between the two groups.Results Before PSM, there were significant differences in baseline data between the two groups (some P<0.05). After PSM, with balanced baseline data, there were 79 patients in each group, and the baseline data were comparable between the groups (all P>0.05). Compared with the open group, the endoscopic group had a longer operative time (Z=-5.415, P<0.001) and increased hospitalization costs (Z=-6.042, P<0.001). There were no statistically significant differences between the groups in intraoperative blood loss, number of lymph nodes removed, drainage volume, and hospitalization time (all P>0.05). Regarding postoperative complications within 30 d, there were no significant differences in incidence rates of intraoperative associated injuries, bleeding, infection, flap necrosis, or subcutaneous fluid accumulation between the two groups (all P>0.05). However, the overall incidence rate of complications was lower in the endoscopic group than that in the open group (P=0.043). Breast-Q scale scores showed that patients in the endoscopic group were more satisfied with postoperative breast shape and had better physical health and sexual health compared to those in the open group (all P<0.05).Conclusion The application of endoscopic technology in early breast cancer BCS is associated with fewer postoperative complications, higher patients' satisfaction, and improvement in postoperative patients' quality of life. It is a feasible surgical approach.